A Public Health Approach to Delivering Breastfeeding Education in WIC

Background: The Oregon WIC program excels at breastfeeding initiation, with more than 90% of Oregon WIC participants doing so. However, by 6 months fewer than half are still breastfeeding and only 36% exclusively. From 2005-2007, Oregon WIC conducted a randomized control trial to determine the impact of a telephone based peer support system on breastfeeding duration and exclusivity. Although a significant improvement was seen among peer counseling clients in partial breastfeeding, exclusive breastfeeding was not increased. As the model showed only mixed success, a new model for breastfeeding peer counseling was needed.

Methods: A multi-level assessment including interviews with existing peer counseling agencies and those not involved in peer counseling, literature review of factors impacting long term exclusive breastfeeding, and formation of a state-local work group to build the prenatal program.

Results: Interviews with coordinators showed an interest in having well educated and professional peer counselors. Peers felt being empathetic and communicative was essential. All wanted more frequent in-person contact with participants. By combining interviews with literature findings, a comprehensive model of breastfeeding support was created. The model defines WIC as a public health lactation program and emphasizes prevention through a series of 5 prenatal groups focusing on self-efficacy and self-discovery. All sessions promote breastfeeding but do so indirectly.

Implications: A peer counseling program focused on increasing long term exclusive breastfeeding needs a different approach than those focused primarily on initiation. The public health approach featured in Oregon's Comprehensive Breastfeeding Support model holds promise for helping more women exclusively breastfeed.